2027 ICD-10-CM Diagnosis Code Z60.4Social exclusion and rejection
Z60.4 is a billable ICD-10-CM diagnosis code for social exclusion and rejection. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is not accepted as a principal diagnosis by the Medicare Code Editor. Coders also document this condition as decreased social isolation. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Socioeconomic/psychosocial factors.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for Z60.4.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Decreased social isolation
- Finding related to ability to interact with others
- Sensory isolation
- Social exclusion
- Social isolation
- Social isolation in parenthood
- Social outcast
- Social withdrawal
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Z60.4: its own notes plus those printed at Chapter 21. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behavior.
- Social isolation
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- target of adverse discrimination such as for racial or religious reasons (Z60.5)
Notes
General instructions on how these codes are used.
- Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can arise in two main ways:
- (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.
- (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Z60.4, its category, or a range that includes it.
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Convert Z60.4 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Z60.4Overview
What is the ICD-10 code for social exclusion and rejection?
The ICD-10-CM code for social exclusion and rejection is Z60.4 (sometimes written as Z604). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Z60.4 (Problems related to social environment) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report social exclusion and rejection on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Z60.4 group to?
On inpatient claims, social exclusion and rejection maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.
Can Z60.4 be a principal diagnosis?
No. The Medicare Code Editor rejects this code as a principal diagnosis because social exclusion and rejection describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.
Can Z60.4 be reported with Z60.5?
Not as a rule. The Excludes1 note on Z60.4 lists "target of adverse discrimination such as for racial or religious reasons (Z60.5)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
